My friend and colleague, Mike Plaut, has another paper out (actually it’s still in press) in the Journal of Health Care Law and Policy. Mike’s writing is great – almost conversational – so I always enjoy reading his stuff. In this paper he describes the work he’s been doing for years at the University of Maryland’s Medical School with health care professionals who act out sexually with patients. Similar to the work I do with disruptive professionals, Mike works individually with physicians and other providers rather than working with groups, and he tailors his interventions to the individual. Now, in contrast to most of my work, Mike holds tighter to the role of the academic advisor than therapist or even coach, as he guides the professional through the relevant literature and has them write a paper about the reason for their referral to him. I typically blur the boundary between coach and therapist as I believe there are more similarities between remedial coaching and psychotherapy than differences, and I have found this to be an invaluable approach to my work with physicians, psychologists, nurses, other healthcare providers and other professionals who have gotten themselves into hot water at work, usually because of interpersonal problems.

I just found an interesting article that is still in-press about fitness for duty evaluations for physicians. A significant part of my practice is devoted to assessing and addressing issues related to physician (and other professional) impairment and disruptive behavior. Much of the consulting I do is with licensing boards, professional associations, hospitals and practices, so this article was of great relevance to my practice. One of the findings that I was particularly pleased to read was that the authors noted that of the physicians they evaluated, most of the time those referred for “disruptive” behavior were assessed as being fit for duty. This is consistent with the majority of my findings; however, this should not be misinterpreted as saying that there are not very significant potential risks and dangers of disruptive conduct within the workplace. In fact, this is precisely what makes it so difficult to perform fitness for duty evaluations for disruptive professionals: though such healthcare providers may not be impaired personally, the effects of their behaviors may (and often do) negatively affect the safety and efficacy of their colleagues performance. So while the disruptive physician may be assessed as being fit, her disruptive behavior may still pose significant problems to the overall functioning of the work environment including compromising patient safety.

Marty Martin, a former Hopkins guy (I think we only briefly overlapped our tenures there), wrote a nice little piece entitled, Taming Disruptive Behavior for the AGProfessional website. As you can see the concepts we talk about regarding disruptive behavior and disruptive professionals applies as much to agricultural professionals as it does to healthcare, legal or other “white collar” professionals.

I just came across a recent article in the AMA’s newsletter, AMedNews.com, about physician (and staff) burnout. Nothing all that new here, but it talks about how overwork and burnout of one member of the treatment team or office staff – – physician or non-physician – – affects the productivity, engagement and satisfaction of others in the office. Many of the physicians and other healthcare workers who come to see me for therapy or coaching suffer from burnout. This tends to be particularly troubling for those professionals who are highly specialized in their training and expertise as they often feel that there are no other options but to continue in their current mode of practice, leaving them to feel trapped. Burnout is relatively easily dealt with once the problem is identified and the professional invests her/his attention and time to the matter of resolving the situation.

I was recently sent an article entitled, “Countering Workplace Violence” that I found to be very well-written and extremely well-grounded. The piece was written in response to the recent shooting in Manhattan, but what I liked most about it was that, unlike other articles, the author avoid the hype and hysteria associated with topics like workplace violence. In fact the author actively countered some very common myths about the incidence of workplace violence and the efficacy of actuarial profiling.

On November 9, 2011, the Joint Commission announced that they will be changing the definition of the term “disruptive behavior.” Specifically, they have noted that disruptive behavior is “behavior or behaviors that undermine a culture of safety.” They added that term is not viewed favorably by some and that many find it to be ambiguous. Though I surely agree with this, I do not foresee an large, wide-reaching entity such as the Joint Commission being able to define a very complex range of behaviors in a way that covers all it needs to cover without going too far. When I give talks about disruptive behavior and workplace violence I often suggest that (unfortunately) the classification of one’s behavior as being disruptive “lies in the eyes of the beholder.” There’s no way the Joint Commission (or even a hospital, small practice or company) could get away with that.

The Wall Street Journal just ran a nice little piece on how to go about choosing the right therapist. I love seeing articles like this in publications like that. The article noted there are different types of therapists, therapies, etc and that what works for one person might not work for the next.

I loved that the author suggested becoming an informed consumer when seeing psychotherapy, but readers should know that some of the suggestion questions are not always answerable. For example, it is perfectly appropriate to ask a therapist about his training or her experience in working with your particular symptoms. It is also quite reasonable to ask about the proposed treatment approach, duration of treatment, etc. However some of these questions cannot be answered definitively after just one session. For example, new patients to my practice often ask, at the end of the initial consultation, how long will therapy take. I explain that I really can’t answer that question with much confidence because there are simply too many variables – – known and unknown variables – – that will affect the duration of our work together.

I add that there are some folks I work with for just a handful of sessions and that is all they need to achieve their desired goals, and there are other people who I have worked with for several years. A key element within longer-term treatment is regularly circling back throughout the therapeutic process and reassessing if it is still appropriate to continue treatment; I would never want to work with a patient (and charge him or her, of course, for services rendered) and have the treatment not be of significant benefit. Ethically, any good psychologist would terminate treatment if s/he feels it is no longer of benefit to the patient.

Here is a nice audio presentation about dealing with disruptive physicians entitled, “Empowering Physicians to Overcome Disruptive Behavior.” I would have liked for Marty to have commented about what resources are available for people who are confronting disruptive behavior. For example, most hospitals has employee assistance programs, in Maryland administrators can seek guidance from Med Chi, the State’s Medical Society, and of course there are independent consultants like myself who specialize in helping organizations deal with disruptive behavior and help coach the disruptive professional toward more appropriate and productive behavior.

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Through individual psychotherapy, I can help you improve your relationships with others in your life, stabilize your moods and cope with anxieties and worries.

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I bring decades of experience working in a variety of settings and with a variety of people to my clinical practice. In addition to doing therapy with couples and individuals, I specialize in helping people like you deal with work-related problems.